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CPT code 46606: Anoscopy biopsy, biopsy performed2026 Medicare rate & RVUs in Washington, DC area

Report this service when standard anoscopy is used to inspect the anal canal and obtain one or more tissue biopsies for pathologic examination.

CMS RVU26DEffective Oct 1, 2026One payment locality1.8K Medicare services in 2024

In Washington, DC area, Medicare pays $356.31 for 46606 in the office and $78.53 when it’s performed in a hospital or facility.

$356.31Office (non-facility)
$78.53Hospital or facility
+16.1%vs the national office rate ($306.95)

Check a contract rate as a % of Medicare · 46606 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 46606 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 46606 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 46606 covers

A clinician examines the anal canal through an anoscope and takes one or more tissue samples from an abnormal area for pathologic evaluation. Colorectal surgeons and gastroenterologists commonly perform this service in an office or procedure room when inspection identifies tissue that needs histologic assessment, such as a suspicious mucosal lesion or ulcer. The biopsy distinguishes this service from diagnostic anoscopy without tissue sampling and from procedures that remove or ablate a lesion.

Report the code when the documented service includes tissue biopsy; record the finding and sampling site. Same-day preoperative and postoperative care is included in its 0-day global period. When related endoscopies are performed together, endoscopy family pricing applies, so the procedures are priced under the family rules rather than each being treated as an unrelated service. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 46606

Across 109 of 109 payment localities, the office rate for 46606 runs from $266.89 in Arkansas to $423.60 in San Benito County, CA. Washington, DC area pays $356.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

46606 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$356.31
  2. Los Angeles, CA · California$354.11−$2.20
  3. Miami, FL · Florida$327.88−$28.43
  4. Chicago, IL · Illinois$317.18−$39.13
  5. Manhattan, NY · New York$355.68−$0.63
  6. Alaska · Alaska$340.47−$15.84
  7. Alabama · Alabama$271.41−$84.90

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

46606 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$266.89$64.32
ArizonaArizona$297.90$69.40
Bakersfield, CACalifornia$330.16$71.71
Chico, CACalifornia$329.59$71.15
El Centro, CACalifornia$329.63$71.18
Fresno, CACalifornia$329.59$71.15
Hanford, CACalifornia$329.59$71.15
Madera, CACalifornia$329.59$71.15

46606 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$266.89

$376.60

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
46606 office rate range by state
State / territoryOffice rate rangeLocalities
AK$340.471
AL$271.411
AR$266.891
AZ$297.901
CA$329.59–$423.6029
CO$322.681
CT$329.251
DC$356.311
DE$303.341
FL$298.82–$327.883
GA$280.03–$312.592
GU$339.931
HI$339.931
IA$280.721
ID$282.541
IL$287.99–$319.444
IN$284.451
KS$278.571
KY$277.391
LA$276.64–$292.452
MA$320.07–$358.492
MD$309.93–$356.313
ME$283.53–$302.142
MI$285.09–$302.402
MN$309.831
MO$270.74–$294.433
MS$268.901
MT$306.941
NC$287.041
ND$302.991
NE$282.691
NH$316.831
NJ$333.20–$351.662
NM$286.621
NV$306.101
NY$291.91–$364.555
OH$284.281
OK$277.521
OR$303.93–$334.862
PA$285.17–$319.662
PR$309.731
RI$315.591
SC$286.101
SD$302.521
TN$280.091
TX$282.97–$321.428
UT$290.601
VA$300.55–$356.312
VI$309.731
VT$301.041
WA$319.71–$366.982
WI$291.361
WV$275.621
WY$305.221

See 46606 in every payment locality

How the 46606 rate is calculated

Each of 46606’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 46606

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.17

1.17 RVUs× 1.000 GPCI

Practice expense7.82

7.82 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

9.1900

Conversion factor

$33.4009

Medicare rate

$306.95

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,601

Code
46606
Physician work
1.17
Practice expense
7.82
Malpractice
0.20

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 46606 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.17× 1.0541.2332
Practice expense7.82× 1.1789.2120
Malpractice0.20× 1.1130.2226
Total RVUs10.6677
Conversion factor× 33.4009

Office rate, Washington, DC area$356.31

Office: (1.17 × 1.054 + 7.82 × 1.178 + 0.2 × 1.113) × $33.4009 = $356.31

Facility: (1.17 × 1.054 + 0.76 × 1.178 + 0.2 × 1.113) × $33.4009 = $78.53

Open 46606 in the RVU calculator

Payment rules and modifiers for 46606

The CMS indicators that decide how 46606 is paid alongside other services.

CMS payment indicators · 46606

Anoscopy biopsy, biopsy performed

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46606 without 51 · national office

$306.95

Anoscopy biopsy, biopsy performed

46606-51 · Second procedure: 50%

$153.48

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 46606

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 46606
CodeHow it relatesOffice range, Washington, DC area
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without tissue biopsy.$149.47
46607Anoscopy, high-resolution exam with biopsyBiopsy performed using high-resolution anoscopy.$262.33
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with lesion removal rather than tissue sampling alone.$354.74
46612Anoscopy, lesion removal by excisionAnoscopy with lesion ablation rather than biopsy alone.$425.13

How 46606 has changed in Washington, DC area

46606 · Office / nonfacility

$356.31

Effective 2026-10-01

The base rate is $47.47 higher than on 2025-10-01, moving from $308.84 to $356.31 (15.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $308.84changed to$356.31

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.20 changed to 1.17
    • Practice expense RVU 6.74 changed to 7.82
    • Malpractice RVU 0.21 changed to 0.20
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $327.74changed to$308.84

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.99 changed to 6.74

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $322.39changed to$327.74

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $342.55changed to$322.39

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.08 changed to 6.99
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $364.14changed to$342.55

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.27 changed to 7.08
    • Malpractice RVU 0.21 changed to 0.20
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $361.98changed to$364.14

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.15 changed to 7.27

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $315.05changed to$361.98

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.92 changed to 7.15
    • Malpractice RVU 0.19 changed to 0.21
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $292.70changed to$315.05

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.49 changed to 5.92
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $276.76changed to$292.70

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.13 changed to 5.49

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $272.22changed to$276.76

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.04 changed to 5.13
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $271.34changed to$272.22

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.03 changed to 5.04
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $272.29changed to$271.34

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.04 changed to 5.03
    • Malpractice RVU 0.19 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $270.93changed to$272.29

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $269.93changed to$270.93

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.00 changed to 5.04
    • Malpractice RVU 0.22 changed to 0.19
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $279.92changed to$269.93

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.60 changed to 5.00
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $279.92

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$356.31$78.53RVU26D
2026-07-01$356.31$78.53RVU26C
2026-04-01$356.31$78.53RVU26B
2026-01-01$356.31$78.53RVU26A
2025-10-01$308.84$82.51RVU25D
2025-07-01$308.84$82.51RVU25C
2025-04-01$308.84$82.51RVU25B
2025-01-01$308.84$82.51RVU25A
2024-10-01$327.74$84.11RVU24D
2024-07-01$327.74$84.11RVU24C
2024-04-01$327.74$84.11RVU24B
2024-03-09$327.74$84.11RVU24AR
2024-01-01$322.39$82.74RVU24A
2023-10-01$342.55$85.43RVU23D
2023-07-01$342.55$85.43RVU23C
2023-04-01$342.55$85.43RVU23B
2023-01-01$342.55$85.43RVU23A
2022-10-01$364.14$87.82RVU22D
2022-07-01$364.14$87.82RVU22C
2022-04-01$364.14$87.82RVU22B
2022-01-01$364.14$87.82RVU22A
2021-10-01$361.98$88.12RVU21D
2021-07-01$361.98$88.12RVU21C
2021-04-01$361.98$88.12RVU21B
2021-01-01$361.98$88.12RVU21A
2020-10-01$315.05$88.56RVU20D
2020-07-01$315.05$88.56RVU20C
2020-04-01$315.05$88.56RVU20B
2020-01-01$315.05$88.56RVU20A
2019-10-01$292.70$87.72RVU19D
2019-07-01$292.70$87.72RVU19C
2019-04-01$292.70$87.72RVU19B
2019-01-01$292.70$87.72RVU19A
2018-10-01$276.76$88.93RVU18D
2018-07-01$276.76$88.93RVU18C
2018-04-01$276.76$88.93RVU18B
2018-01-01$276.76$88.93RVU18AR1
2017-10-01$272.22$88.85RVU17D
2017-07-01$272.22$88.85RVU17C
2017-04-01$272.22$88.85RVU17B
2017-01-01$272.22$88.85RVU17A
2016-10-01$271.34$88.84RVU16D
2016-07-01$271.34$88.84RVU16C
2016-04-01$271.34$88.84RVU16B
2016-01-01$271.34$88.84RVU16A
2015-10-01$272.29$89.13RVU15D
2015-07-01$272.29$89.13RVU15C
2015-04-01$270.93$88.69RVU15B
2015-01-01$270.93$88.69RVU15A
2014-10-01$269.93$89.08RVU14D
2014-07-01$269.93$89.08RVU14C
2014-04-01$269.93$89.08RVU14B
2014-01-01$269.93$89.08RVU14A
2013-10-01$279.92$87.13RVU13D
2013-07-01$279.92$87.13RVU13C
2013-04-01$279.92$87.13RVU13B
2013-01-01$279.92$87.13RVU13AR

Price 46606 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

46606 billing questions

When should this be reported instead of 46600?

Report 46606 when anoscopy includes tissue biopsy. Use 46600 for diagnostic inspection without tissue biopsy.

How does 46606 differ from 46607?

Both include biopsy, but 46607 is for diagnostic anoscopy using high-resolution magnification. Report 46606 for biopsy with standard anoscopy.

Can the biopsy be reported separately from the anoscopy?

The biopsy is part of this anoscopy service; do not report a separate code for the tissue sampling itself.

Should modifier 50 be appended for bilateral findings?

No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

What happens when related endoscopies are performed in the same session?

CMS applies endoscopy family pricing to related endoscopies performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 46606PPRRVU2026_Oct_nonQPP.csv, line 5,601 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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